Apparently something's going on here on ScienceBlogs. It's something that I don't like at all. You, my readers, have been informing me of it. Oddly enough, it also jibes with potential blogging material that appeared on that wretched hive of scum and quackery, The Huffington Post. You'll see what I'm talking about in a moment. Suffice it to say that it is not a confluence that makes me happy. It's not even a confluence that amuses me. Rather, it's a confluence that should never, ever happen. But happen it has.
It began with advertisements that have been popping up. Unfortunately, after a long period of time having been banished successfully to whatever Internet netherworld they come from, the dubious ads are back on ScienceBlogs. The first one showed up a week or two ago; it's an ad that's been everywhere featuring a creepy 72 year old face on a ripped body and touting an "anti-aging" medical practice known as Cenegenics. All you need to know about Cenegenics is that it appears to be nothing more than human growth hormone quackery. And it's here on ScienceBlogs. In all fairness, I will point out that I did complain about it to advertising. I received no response from the advertising person, although our intrepid intern assured me that if I pointed the ads out they should disappear. Indeed, I thought they had disappeared. Unfortunately, yesterday my wife informed me that they haven't.
But that's not the worst of it. This is:
It's an ad for Synaptol, which bills itself as being able to do the following things:
- Safely and quickly relieves ADD / ADHD symptoms including hyperactivity, inattentiveness, poor concentration, and difficulty reading and writing
- Balances energy levels and provides therapeutic support for optimal overall health and vitality
- Provides fast, effective, natural ADD / ADHD symptom relief in children and adults with no negative side effects*
And here's the reason why Synaptol can claim to have no side effects:
Synaptol is an OTC formulated proprietary natural medicine, featuring FDA approved active homeopathic ingredients + an oligotherapeutic water base for superior, natural ADD / ADHD symptom relief. Synaptol's approved ingredient blend quickly starts working with your body for natural relief, and promotes overall health. Imagine your family's fast return to a better quality of life - symptom free!
Our unique approach utilizes a multi-directional process to safely relieve ADD / ADHD symptoms and to naturally promote a healthy lifestyle marked by energy, vibrancy, and a fresh approach to life.
That's right, Synaptol is homeopathy using these ingredients:
Aconitum Ferox, Adrenalinum, Apis Mellifica, Argentum Nitricum, Avena Sativa, Baptisia Tinctoria, Cochlearia Armoracia, Medorrhinum, Phosphorus, Scutellaria Laterifolia, Sumbulus Moschatus, Viola Odorata
Other: Aesculus Hippocastanum, Litsea Cubeba, Madia Elegans, Mentha Piperita, Myosotis Sylvatica, Ranunculus Occidentalis, Scleranthus Annuus.
Each of the active homeopathic ingredients in Synaptol is included at a potent 10X, 30X, and 100X dilution, and stabilized in our oligotherapeutic water base for maximum absorption and balancing response. Synaptol also contains a proprietary Oligotherapeutic Neurotransmitter Health Complex to promote optimal synaptic health.
One can't help but notice that we're looking at some very minimal homeopathic dilutions. In fact, there are probably real homeopathic substances actually present in the remedy. Be that as it may, ScienceBlogs is now advertising pure quackery.
Here's where the uncomfortable confluence comes in.
Just yesterday, everyone's favorite apologist for homeopathy whose arguments are, well, homeopathic in their logic, reason, and science, with the exception that in his case diluting his argument does not make it stronger, Dana Ullman, dropped another turd of undiluted nonsense entitled Homeopathic Alternatives for Children with ADHD.
As usual, Dana Ullman begins by attacking conventional medicine, pointing out that the drugs we use for ADHD (attention deficit hyperactivity disorder) or attention deficit disorder (ADD) have come into question. Hilariously, he tries to appropriate the concept from homeopathy of "like cures like" to claim that Ritalin is based on homeopathic concepts:
It is initially surprising and confusing to learn that Ritalin is an amphetamine-like drug. One would think that this type of drug would make hyperactive children even more hyperactive. However, when Ritalin is prescribed to children who are already hyperactive, it tends to slow them down. Ironically, the use of a drug that causes symptoms similar to those of the patient is actually the basic principle of homeopathic medicine (treating "likes with like").
This is typical Ullman. He appropriates legitimate medical therapies and then tries to convince his readers that they are in fact based on homeopathic principles. He's done it with vaccines, digitalis, nitroglycerin, colchicine, and allergy shots. This argument is utter nonsense, of course. All of these medical treatments are based on pharmacology, physiology, and biochemistry. Their effectiveness has nothing to do with homeopathic concepts, although Ullman has in the past tried mightily to appropriate them for his favorite pseudoscience. Even Ullman appears to seem aware of this, as he later admists that these are not "true" homeopathic medicines because they have actual medicine in them and because they are not "individualized" according to homeopathic principles.
As is typical with Ullman, he then cherry picks a bunch of low quality studies, the first of which is Frei and Thurneyson. This study was an open-label study, which means it was not blinded. This makes it useless, so much so that one wonders why the investigators even bothered. Also, it was not even placebo-controlled. Basically, all the children in the study received homeopathic treatments, and those who didn't improve were then switched over to standard medical therapies. Not surprisingly, this study was published in the British Homeopathic Journal.
The next trial cherry picked by Ullman was actually published in a real journal. I'm not sure why, but it was, even though it's only marginally better than the first study cited by Ullman. The study is Frei et al. Note that it's the same author as the first trial and that Thurneyson is the corresponding author, meaning it's the same research team. Unfortunately, my university doesn't have subscribe to this journal, at least not online; so I only had access to the abstract, but the abstract is quite telling. According to the abstract, prior to the start of the randomized trial, 83 children aged 6-16 years with ADHD diagnosed using DSM-IV criteria (what, no homeopathic diagnoses?) were treated with "individually prescribed homeopathic medications." Out of these children, 62 who achieved an improvement of at least 50% on the Conners' Global Index (CGI), a measurement of ADHD, were then enrolled in a randomized, placebo-controlled trial. Of course, whenever I hear "placebo-controlled" with respect to any trial of homeopathy, I can't help but wonder how on earth one tells which is placebo and which is homeopathic remedy, given that homeopathy is water. Be that as it may, the investigators then did a crossover design, in which children were randomized to placebo or homeopathy at the beginning, and then at the 6 week mark each subject crossed over to the other group. The results were as follows:
At the beginning of the trial and after each crossover period, parents reported the CGI and patients underwent neuropsychological testing. The CGI rating was evaluated again at the end of each crossover period and twice in long-term follow-up. At entry to the crossover trial, cognitive performance such as visual global perception, impulsivity and divided attention, had improved significantly under open label treatment (P<0.0001). During the crossover trial, CGI parent-ratings were significantly lower under verum (average 1.67 points) than under placebo (P =0.0479). Long-term CGI improvement reached 12 points (63%, P <0.0001).
Wow. That's a mighty...interesting p value. It's barely statistically "significant." Does this mean that the results are invalid? Not necessarily, but I'd want to take a close look at what statistical tests were used. As for the long-term clinical improvement, that is a meaningless number, given that all of the children received homeopathy and all of theme crossed over.
The third study that Ullman cited actually surprised me. No, it didn't surprise me that the study was completely negative. It was, after all, a study of homeopathy, which is no different from water. Basically every subject in the study underwent a homeopathic consultation and then received either an individualized homeopathic remedy or a placebo. In any case, what surprised me is that Ullman actually cited this paper. I suppose he cited it because he bought into the handwaving by the authors, who tried to make the proverbial silk purse out of a sow's ear by concluding, "A therapeutic effect of the homeopathic encounter is suggested and warrants further evaluation. I'm not sure how they managed to conclude that. I looked at the paper and the "money figure," which plots the Conners' Global Index scores of both control and treatment groups over time. A more perfect overlap is rare to find in a clinical trial. There really was no detectable difference between the curves. But the corresponding author of this study was our old friend David Katz, he of advocating that physicians accept a "more fluid" form of evidence than that nasty evidence- and science-based medicine. He's good at trying to salvage some positive claim for himself when the evidence is stacked against him.
Next up on the list is another study from the British Homeopathic Journal that is unusual in that it comes from a single author, John Lamont, PhD. Also interestingly, Ullman didn't include a link to this reference, for reasons that are unclear. In any case, this was a small study of 43 children, and for some reason it, too, was a crossover design study. This made me wonder: What is it with homeopaths and crossover studies? And why can't they do them right by including a washout period between the two interventions, placebo and homeopathy. Crossover studies can be appropriate when examining a series of two treatments, but given that this was a straightforward comparison of homeopathy to placebo, the crossover design seems redundant and more likely to confuse results more than anything else. For such a small pilot study, a simple design of control versus treatment design would be more straightforward. Another curious thing about this study is that all improvement is parent- or caregiver-assessed. Investigators did not use the standardized Conners' Global Index. Finally, the study was not truly randomized; rather it was quasi-randomized using alternation. Worse, the allocation was done by the clinician, who was also the researcher who did the study, which meant that assignments were easily predictable.
I remain unimpressed. I do, however, marvel at how homeopaths can dilute their remedies to 200C, as they did for this study, and still think that they are anything other than water. Apparently their ability to do clinical research is just as diluted as their 200C remedies, and this is another case where dilution does not result in stronger remedies.
Finally, Ullman notes that there is a Cochrane Collaborative review of the use of homeopathy in ADHD. This review concludes:
The forms of homeopathy evaluated to date do not suggest significant treatment effects for the global symptoms, core symptoms of inattention, hyperactivity or impulsivity, or related outcomes such as anxiety in Attention Deficit/Hyperactivity Disorder.
And:
There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD. Development of optimal treatment protocols is recommended prior to further randomised controlled trials being undertaken.
This is what I hate about Cochrane. No matter how fantastical the therapy, no matter how resoundingly negative the evidence, Cochrane reviews almost always conclude that "more research" is needed or provide some weaselly comment like the one above. Amusingly, Ullman complains that this Cochrane review didn't include his favored studies. Similarly, he engages in some serious contortions to try to argue against the Cochrane Collaboration:
The Cochrane Collaboration is an internationally respected group of researchers who evaluate research. In their review of homeopathic treatment of children with ADD/ADHD, they concluded, "There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD" (Coulter and Dean, 2007). It is important to note that they stated that there was "little evidence," not "no evidence," that homeopathic medicines have been shown to be effective in the treatment of children with ADD/ADHD.
Further, it should be noted that the Cochrane Collaboration maintains a very high standard for their definition of "efficacy," and they commonly note that there is "little" or "no" evidence for various commonly used conventional medical treatments, despite the billions and billions of dollars spent on them by individuals, insurance companies and governments.
Talk about excuses! Basically, Ullman doesn't like the fact that the Cochrane Collaboration found no benefit to children with ADHD that could be ascribed to his brand of sympathetic magic; so he tries to wave off the negative results. He also whines that studies looking at homeopathy are different from each other. Here's a hint, Dana: That's true of virtually every single topic that the Cochrane Collaborative performs its systematic reviews on! Not surprisingly, Ullman also invokes the tired old canard that, because homeopathy isn't sold by big pharma, there isn't much money in it and there are fewer studies.
Ullman finishes his article with a curious detour. After having discussed treating ADHD with homeopathy, suddenly he starts pointing to studies suggesting that pesticide exposure might be correlated with ADHD. So little relationship to the text before does this section have, that I seriously questioned whether Ullman had pulled a cut-and-paste error, in which he inadvertently pasted a six paragraph segment from another article he was writing into this one.
Basically, what it all boils down to is that Ullman is spinning, spinning, spinning. Given the quack ads that have been appearing on ScienceBlogs lately, including the Cenegenics ad, ads for Synaptol, and--gasp!--ads for Cancer Treatment Centers of America, I hope that whoever's in charge of advertising these days doesn't get the bright idea to hire Dana Ullman as a copy writer.
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Orac is totally ignorant when it comes to homeopathics. There are documented cases of cures from homeopathic remedies and I for one, have seen many. As for homeopathic remedies being just water, I would love to see Orac try a homeopathic remedy and what he/she has to say with in hours. Sadly, Orac is commenting on something that he/she has clearly never tried or studied. Most Sceptics do not understand how homeopathic remedies work, they exaggerate and misconstrue what homeopathic remedies are and ironically see themselves as the defenders of medical science, but in truth they have an embarrassingly poor scientific attitude when evaluating homeopathy and the remedies!
Well? I'm sure everyone is waiting with bated breath.
Does it start with a Q? You're being awfully coy.
jenny, did it take you a whole year to come up with that comment where your evidence is so diluted it is actually homeopathetic.
jenny,
Since Orac is so ignorant of homeopathics, perhaps you would help educate us.
What are the basic principles of homeopathy?
I will also add my three basic questions for any advocate of an alternative medicine:
1) What has been the biggest improvement in your field in the last 100 years?
2) What methods or treatments have been discarded in the last 100 years because either they were found not to work, they were found to have too many problems to justify the benefit, or a better method was found (more effective or less side effects)?
3) How do practioners in this field determine what works and what doesn't?
Which leads to your reference to documented cures from homeopathic remedies. I've somehow missed seeing the documentation for those cures. Would you please provide a link to the published case studies where those cures are documented? The Pubmed ID's will suffice.
And, as Chris hinted, since Orac writes frequently about homeopathy and did two blog articles recently (look for plausibility in the title) that discussed it directly, what led you to pick this year old blog to comment on?
Could be that homeopathy is really just advertising and quackery?
jenny, us skeptics are able to ridicule homeopathic products without having to exaggerate or misconstrue.
We base our ridicule on exactly what the homeopathic industry tells us about their products. Diluted and shaken? The industry makes itself a target all by itself with this nonsense.
Oh and jenny, I doubt if Orac would have anything (positive) to say a few hours after trying a homeopathic product. Your pellets are 100% sugar. It says so right on the label of Oscillo, for instance. Two kinds of sugar, to be precise, 85% sucrose; 15% lactose. That 100% sugar content doesn't leave much room for any "active" ingredients.
Haven't you ever seen the videos where skeptics swallow entire packages of homeocrapic products, quantities of which would induce overdoses if real drugs were taken? No side effects, no toxicity, no overdoses. Except for maybe some possible tooth decay from all that sugar.
And jenny, are you aware of the multi-million dollar lawsuits around the world against Boiron for making FALSE claims?
Finally jenny, would you recommend homeopathy for malaria prevention? Or AIDS? Or rabies?
I've read that many of the ailments for which people see their family doctors will be naturally cured by their own bodies in 48 hours or so, if they just stay home and get bedrest and fluids.
So, yes, if people take homeopathic remedies-- i.e., water and sugar pills-- they are very likely to feel better "within hours." Not as much better as if they had stayed home and had chicken soup, but still.... ;-)
jenny
Well, then, please fill us in.
But please avoid both invoking the supernatural, and using terms you don't actually understand.
I just got an ad for an herbal PMS remedy. It's getting pretty bad. Every time I go to your blog there is a dubious health product ad there.
I've noticed the trend in ads. Over on Ed Brayton's blog, I'm seeing ads for Michelle Bachman.
To add insult to your insult, I'm seeing an ad for "hCG" in the top banner. Following the link, there's the Quack Miranda front and center (albeit in tiny type.)
On the good side, there's an ad for Vyvanse on the side-bar. That looks like a more legitimate ADHD treatment (it's a CII amphetamine derivative.)
An AdBlock a day keeps quackery ads away.
I suppose the "Ritalin operates on homeopathic principles" argument shouldn't surprise me, though once again it reveals the paltry shallowness of Ullman's thought processes. If it treats in a "like-cures-like" manner, why would it work that way *before* homeopathic dilution and potentiation? That is to say, unlike a homeopathic remedy*, it most certainly does not produce the same effect as the illness.
The reason stimulants work on ADHD is undoubtedly for the same reason that ADHD symptoms are so strongly mimicked by normal people who are overtired and overstressed. (Compare an ADHD sufferer and a child two hours past her bedtime who has reached that "second wind". Pretty much the same, eh?) To put it very crudely, when the brain is tired, it isn't very good at regulating itself. Wake it up a bit, and it doesn't wander so much.
* I say unlike, but actually this same criticism works for a lot of more common homeopathic remedies too. They don't really cause the symptom quite the right way, or in some cases don't cause the symptom at all. Homeopathic provings are frequently more imaginative than descriptive, and there is nothing at all systematic or really disciplined about the process. Homeopathy has, at best, the appearance of discipline.
The first one showed up a week or two ago; it's an ad that's been everywhere featuring a creepy 72 year old face on a ripped body and touting an "anti-aging" medical practice known as Cenegenics.
Which, not coincidentally, was the ad displayed at the top of the page when I read this post (I probably wouldn't have noticed if you hadn't called my attention to it, since I try to ignore web ads when possible). It's the old keyword-based advertising snafu again: the ad server notices you are discussing Cenegenics (or that Ed is discussing Ms. Bachmann) without noticing your opposition, therefore it serves up an ad for Cenegenics (or Ms. Bachmann, in Ed's case). It's been a recurring problem here (this is at least the third episode I know of at ScienceBlogs where keyword-driven ad servers display an ad for something explicitly opposed in the text of the post), so I'm not sure there are any long-term fixes you can do. It's the ad servers that need to get smarter, or we will continue to see these ad targeting fails.
I know this is dubious comfort, but you can at least be sure that the people who placed those ads are paying some (admittedly small) amount of money for your post in opposition. Not an ideal solution, but I don't have anything better to offer.
"given that this was a straightforward comparison of homeopathy to placebo, the crossover design seems redundant and more likely to confuse results more than anything else."
That's not a bug; it's a feature.
Ironically, the creepy old guy on the ripped body showed up for my next to this article. He's following you!!
Re advertisements: while I *do* hope that they're on their way out, you have to admit that it's kind of funny that woo-tainted entrepreneurs *pay* to appear on a site that consistently tears their metier to shreds and is read by many who would certainly never buy the products- thus, they're wasting their ad budget in the *wrong place* with few likely customers. Ha ha.
On Ullman: he does a few things like *les autres* I review- they all quote Cochrane ( even when it doesn't fit their needs, as here) -another way to convince the marks that they're indeed *doing real science*, along with the cites of studies that are tiny, foreign, or done by the perps themselves. However, although they shamelessly ape scientists, they often rant against the "soul-lessness", COI's, or downright evil inherent in science itself. Go figure-( but then were you expecting consistency from those who state that a weaker concentratuon is actually stronger?)
Harping on the evils of BigPharma: amongst its greatest sins is the prescription of "toxic meds" to *children*- here we have anti-psychiatry plus "save the children" simultaneously. The idea that Pharma "poisons" ( a/k/a "street drugs") are used to treat an LD, already rife with stigma, is too much for the woo-entranced to bear. Thus, parents of kids with ASD's and LD's are prime targets for "safe" treatments like homeopathy, herbs, supplements ( see ads @ AoA; Mike Adams' many rants on the subject; Gary Null films: "The Drugging of Our Children"; "Autism: Made in America".)
Currently, I think that the idea of replacing Pharma with "safer" products and SBM with woo is where all of these merchants are headed. The writing is on the wall- as well as in NaturalNews. My greatest fear hinges on the possibility that in a climate of de-regulation and where funds for government-sponsored medical care are increasingly scarce, amazingly bad events might transpire. Consider the possibilities.
I think their insistence on mentioning the Cochrane review is simply to play off the respectability of that process; if it's reviewed by Cochrane it's real science. No need to confuse the public with the actual content of the review. Maybe the Cochrane people need to add some Ebert-like "thumbs up" and "thumbs down".
I too noticed the ads across the top, when I was using the newer laptop that my husband uses...he was doing some techie things on mine. Just yesterday, we opened RI together and I showed him the difference. He went into the program and used the (ad blocker?) function to eliminate them.
When I "slum" over at the Huffington Post and find an interesting (non-woo) article I will post...my little way of supporting the author. Two days ago I wrote a complimentary post to the author of an article dealing with the Wakefield fiasco and its impact on research into genetics on autism and effective behavioral/educational therapies for children with ASD. That same day I also posted a comment on Kirby's latest drivel...the Pace "study"; "held for moderation" for a few hours then never published. I tried to keep (much of) the snark out of it.
I also note that some of the "better" articles have woo doctors, woo treatments and woo supplements ads just beneath the articles.
Not necessarily, I'm afraid. Often the advertiser only pays for clicks, not views.
Lilady @ 10 -- I too often slum over at HuffPo, trying to be a beacon of reason and enlightenment among the unscientific heathens and trolls. Their moderation is weirdly inconsistent. I've tried to comment on Lanza's articles, which are industrial-strength nonsense without exception, and hardly ever gotten through, no matter how polite I am. But the Ullman articles tend to be less strictly moderated, and a Greek chorus of scornful skeptics join the battle. Their antivax articles are refuted very well by such critics as Sheldon101, who's basically a public-health hero as far as I can see. On climate change HP is on the side of the angels, more or less by accident, but any climate change article attracts a squadron of denialist trolls, who are patiently demolished in turn by posters who actually know what they're talking about.
It's entertaining, at least for a while.
@ lilady: Seriously, I doubt that AoA would allow anything but utter agreement with their own patented brand of wankery. I commented OT here (@ the Morgellons post) about JB's recent *classic* "de-construction" of our esteemed host, hoping that sister & fellow minions would *respond politely*. I guess we wouldn't know because they won't publish dissonance. If they did, they probably would just say, "It's only Orac pretending to be a girl" or "It's someone 'paid' to defend him", i.e. the usual tripe.
Since when is a concentration of ZERO ppm considered potent?
At least the mineral water ("oligotherapeutic water") used as the base assures there's something more than simple hydrogen hydroxide in this bottle of placebo. But last I checked, I could buy mineral water at the grocery store by the liter, and nowhere on the bottle was there an indication for ADHD or "ADHD symptoms."
Kids who are given a worthless quack remedy for ADD/ADHD are less likely to be successful at learning.
That translates to "more likely to grow up unable to distinguish between medicine and woo".
Win-win for the quacks.
I don't see any of those ads.... oh wait, I have adblock. Works well apparently
That damned Synaptol ad is appearing everywhere, not just ScienceBlogs.
I wish somebody with better investigative reporting chops than I have would figure out the corporate connections for HelloLife (the company marketing Synaptol).
Evidently Synaptol was introduced a year ago.
HelloLife is based in Grand Rapids MI and is part of Ionx Holdings (Hello Life Wellness Center Inc., and Micronutra Ionx Inc.) and the CEO and president is Albert Duoibes.
Today's press release:
The ad I see now is for Huggies Pullups. I guess even GoogleAds can eventually figure out that quacks are full of it... and not quite ready for the big-boy pants, perhaps?
-- Steve
Orac, you are not the only one with this problem. The Politifact website always have ads for dubious products, and I have asked them whether they intend to fact-check those too. The response I got was equivocal, but if a large enough number of people asked them the same question it might just prompt them to do so.
er? Does that mean each ingredient is present in each concentration*? Would homeopaths insist that's meaningfully different from 10X of each?
* OK, "present" isn't a very meaningful notion at 30X or 100X.
Count me among the people using Adblock Plus. It's a neuron saver!
On those study designs:
I always wanted to learn more about how to design experiments and choose statistical tests to avoid false positives than I got out of my courses. I may just waltz over to CAM journals, write down what they do, and make notes to never, ever do that, since they set out by design to do what I'd do by ignorant mistake.
@Andreas Johansson--
I've always found those mixed-dilution homeopathic preparations to be amusing. It's funny that they can't be bothered to calculate or report the true dilution resulting from this combination, and downright hilarious that they think the mix would have different properties.
@ Palindrom & Denice Walter. The "good" article on the H-P that I posted on is "Supporting Autism Science" by Todd Drezner...where I again debunked the infamous deliberately redacted/edited study about 48 kids who had a severe neurological event following a measles vaccine. Guess what the original troll who did the posting of the bogus citation came back at me. So...."lilady" re-posted again, about 10 minutes ago. If you have time you might want to post...not for support of me, but rather to keep the discussion going. (I think H-P may leave the blogs up longer when there is posting activity).
I looked up the author "Todd Drezner"; he is the director of a new movie "Loving Lightposts" and is featured in the movie with his youngster diagnosed with autism who has a favorite lamppost.
@madder: I take that that the answers to my questions are yes and yes.
Actually, I don't expect that there will never be dubious ads. As long as keyword-based ad systems are used, there will always be some questionable ads, and, for instance, I don't know if I would go to the mat over Cancer Treatment Centers of America ads. However, I would just like there not to be ads for pure quackery like homeopathy and hGH anti-aging quackery. Is that too much to ask?
One notices that this problem resurfaced soon after National Geographic took over the operation of ScienceBlogs.
"Of course, whenever I hear "placebo-controlled" with respect to any trial of homeopathy, I can't help but wonder how on earth one tells which is placebo and which is homeopathic remedy, given that homeopathy is water."
Properly blinded homeopathic studies must be the best blinded studies of all. Not only do the subjects and investigators not know who is in the control group, it is impossible to tell which is the actual remedy and which is the control. No amount of chemical testing will be able to reveal which is the actual remedy and which is the placebo!
What would they ever do if the labels fell of the bottles?
-Karl Withakay
@Andreas Johansson--
As far as I can tell, you're right. Someone else coined the term "fractally wrong;" here's a view at yet another scale.
Karl -- they'd stick the labels back on and whistle innocently. :-D
WTF is "oligotherrapeutic"?
"Oligotherapeutic" = "will only be therapeutic in a few cases."
Oligotherapeutic" = homeopathic mineral water.
Crap. I hope the 10X dilution is something like peppermint and not adrenaline or Indian aconite. Come to think of it, would adrenaline have a similar effect to conventional drugs for ADHD?
ALL of the ads coming up on your site are medical Quack ads hawking impossible cures.EVERY SINGLE ONE OF THEM.
#27 madder: "fractally wrong"
Thanks for bringing this excellent phrase to my attention. Love the examples here.
@ #8 Denise:
"My greatest fear hinges on the possibility that in a climate of de-regulation and where funds for government-sponsored medical care are increasingly scarce, amazingly bad events might transpire. Consider the possibilities. "
With regards to ADHD, at least, right now represents a bit of a lull in bad events that have been transpiring for a while. Diagnosis and treatment rates in children are at least approaching the estimated prevalence rate for the condition itself, although for adults it's still pretty low, probably because so many people have slipped through the cracks in the past due to a general lack of awareness or the effects of idiotic propaganda from the "ZOMG don't drug the kids!!!" crowd. Even Britain's NHS finally relented in 2009 and accepted that ADHD continues into adulthood and doesn't magically end on one's 18th birthday.
Ironically, at least some of the lack of awareness of effective treatment (the FDA approved drugs based on amphetamine, methylphenidate, or atomoxetine) might be due to government regulations that place limitations on advertising for controlled substances, since all ADHD drugs except atomoxetine (Straterra) are Schedule II Controlled Substances.
That makes it difficult to make the general public aware of exactly how effective these medications are. The end result is that it's far easier for Synaptol and Ullman to spew their crap than it is for Shire and Novartis and Lilly to spread the message that current ADHD medications have an efficacy rate of 70-80%, which is damn near miraculous but also fairly well supported by published literature.
And that's just dealing with the snake oil salesmen. There's also the people who vociferously insist that ADHD doesn't exist, or that it's just a "trait" or that "it's a gift, not a curse." As you note, usually these are the Anti-Psych nutjobs. Wikipedia's ADHD page was so infested with them (and still is) that they had to split off a separate "ADHD Controversies" page just to give them their own soapbox.
Given the known long-term consequences of untreated ADHD, I agree that the results of these efforts would be very bad. I just have to hope that the progress that has occurred over the past 2 decades continues rather than slipping back into the dark ages.
The banner ad at the top as I'm writing this is for Travelodge. I'd love to know how the keyword algorithm came up with that one.
Looking up the list of ingredients for that homeopathic nostrum is fascinating in its way. Most of those things are fairly innocuous herbs, though Aconitum ferox is strongly toxic, a few others like Scutellaria laterifolia more mildly so. And then we have adrenaline, silver nitrate, phosphorus, and "Apis Mellifica" (ground up whole honeybees). And "Medorrhinum" -- what's that? Turns out it's made from the pus of gonorrhea infections. As Orac pointed out, some of the dilutions they list could leave active ingredients. I don't say that there are any live Neisseria gonorrhoeae bacteria in this concoction, but...
"This is what I hate about Cochrane. No matter how fantastical the therapy, no matter how resoundingly negative the evidence, Cochrane reviews almost always conclude that "more research" is needed"
Cochrane is evidence-based. That means that negative findings in studies designed to reject a null hypothesis do not necessarily prove the null hypothesis. Rejecting the possibility that a hypothesis is correct is different than failing to prove it is correct. That is a subtle but important statistical point.
The Cochrane reviewers are absolutely correct. A stronger negative statement would require going beyond the strength of the evidence.
Spare me the lectures on the meaning of the null hypothesis; I'm well aware of what it means and how statistics are applied. I've heard this before. The problem is that Cochrane and EBM in general are not evidence-based enough in that they ignore the scientific evidence that demonstrates that homeopathy to be nonsense from the very start. That is the problem with Cochrane that I was referring to.
Scientific nonsense + negative clinical trials do not equal "need for more research." Yet that's almost always what Cochrane concludes when doing systematic reviews of quackademic medicine like homeopathy.
@ Hyperion: (c. 1994) a few events happened quasi- simultaneously- the increase in ASD diagnoses via DSM-IV changes, the growth of the internet, and advent of DSHEA- which have evolved into the sorry state we now witness where barely-literate charlatans preach the gospel of anti-pharmaceutica and victory through vegetables and supplements to a large audience.
In reality, parents with ASD- or LD- diagnosed kids are extremely vulnerable to predatory salesmanship techniques: they have a stressful life as caretakers in post-institutional society ( there are many stories of their woes @ AoA) and an uncertain future. Woo-meisters swoop in with false promises of cure and definitive answers concerning causation : "Pharma did it!" ( by vax) or made it worse ( by meds)!
The trust engendered in unsuspecting parents is based on spurious credentials, illegitimate "studies", and disingenuous advertising taking advantage of them in a time of weakness, turmoil, and distress. "Con job" implies that the bilker must first inspire "confidence" in the mark. It's a "set-up". I deliberately use the language of *noir* fiction and crime film.
In the early 1900's, Collier's Magazine revealed how patent medicines traded on the lack of information by a trusting public. I think that it's time for another go-round there focusing on woo this time.
Why have these people apparently not considered doing their testing on adult ADHD patients? After all, we're capable of telling them coherently what difference their treatments make to our experiences.
Probable answer: Because we'd be capable of telling them they make none.
I can see ads for hotels and ads for "Do you qualify for grant money? Follow the phishing signs to find out." Aside from the potential phishing however, I see no woo.
Maybe they ad generators sense my antipathy for homeopathy?
In regards to the Ritalin piece it would nto have taken much for him to find a study, well the press release at least, that explains one reason why a stimulant would calm someone down http://www.eurekalert.org/pub_releases/2008-07/vumc-po070708.php#
Here is the link to the study http://www.jneurosci.org/content/28/28/7040
I don't see it posted elsewhere, but here is (apparently) the article by Frei that you didn't have access to:
www.heinerfrei.ch/downloads/Downloads%20Publikationen/ADHD_DB_Trial_eng…
It is a rough PDF version, but I think it should work. (I often don't have access and so look around a lot. Hmmm. Where did Google Scholar's ability to look for documents of type PDF go? That was useful...)
Wow. just wow. these people have no scruples at all.
I'm amazed when I'm occasionally reminded that some people actually see ads on web pages. My brain automatically classifies them as noise.
You consider Ritalin a "legitimate medical therapy"?
Yikes. Enough said about your opinion... I'm not one to look to homeopathy remedies for anything but Ritalin is a disaster.
I see La Quinta ads everywhere, including on Science Blogs, because I visit their website once a year to make a reservation. Today, however, La Quinta has been muscled out of the way by the ancient body-builder from Cenegenics.
Yikes @47
Said the commenter who offered no citations/links to the commenter who did.
O great Orac: the Synaptol and buff old guy ads here are okay, but it was the Christian dating site ads that kept popping up over at Pharyngula recently that really made my day.
I'm getting Cenegenics ads here (clamboy's "buff old guy" one), while typing a comment, and the Synaptol one was before I clicked through; I also got the Christian matchmaker one on Pharyngula a moment ago, "Stand with Michelle Bachmann to Defend Traditional Marriage" and another Bachmann one about "Are you satisfied with the current field of potential Republican presidential candiates?" (Ummmm... No!) at Dispatches.
I believe, though, that they are paying by 'impressions' not click-thrus and so, if I am correct, then we can feel good that bad messages are supporting good sites and being wasted where they are least likely to do harm.
I get ads for MathType and Symantec. I've never seen the "buff old guy" or the homeopathic nostrum.
@47 Yikes:
http://www.ncbi.nlm.nih.gov/pubmed/8919704
"One hundred fifty-five controlled studies of 5,768 children, adolescents, and adults have documented the efficacy of stimulants in an estimated 70% of subjects."
If 70% efficacy rate is a "disaster," then I'd imagine that there are plenty of researchers who would love to discover a "disaster" like that for their field.
When you factor in misdiagnoses and patients who might have done better on a higher or lower dose or patients whose experienced side effects that were bad enough to discontinue treatment, efficacy rates like those are damned near miraculous.
It's understandable, you've been misled by these charlatans (and others who, for various reasons, simply refuse to believe that the disorder even exists despite mountains of evidence to the contrary). This is tragic because ADHD, unlike many other neurodevelopmental disorders, has effective treatments such as methylphenidate, which has been in use since the 1950's, and amphetamines that have been used to treat the disorder since the 1930's.
Prevalence estimates vary, but there's a decent consensus that the condition affects about 5% of the population. When untreated, the condition leads to significantly higher risk of dropping out of school, or substance abuse and addiction problems, of unemployment and underemployment, unintended pregnancy (if you can barely find your car keys, remembering condoms isn't all that likely either).
The disaster is not Ritalin. The disaster is that 1 in 20 kids have a condition that puts them at risk of dropping out, that gives them maybe a 5% chance of ever graduating from college but something like a 30% chance of developing a substance abuse or addiction problem, and most places don't have mandatory testing for children entering school because there's more outrage over the possibility of giving kids medication than there is over what happens to the kids who fall through the cracks.
And while a good part of that anti-medication propaganda comes from know-nothing anti-psych twits, a lot of it is also fed by ripoff artists like the people who market this Synaptol crap, because they see dollar signs in perpetuating myths regarding medication treatment. They're not just preying on gullible parents, they're actively attempting to convince people to forego effective treatment options, and they will do or say anything it takes to do so.
Even the worst stereotypes about the pharmaceutical industry don't come close to the pure evil in lying to parents and convincing them to avoid effective treatment for their children just to make a qujck buck.
@53: i am an adult with ADD and all of those things came to fruition for me. I was diagnosed at a fairly young age (11 or 12) - but did not receive medication for it until 14 or so. I was again diagnosed with ADD as an adult, and a fairly BAD case of it, too. However i don't have the means for medication now, because, as was mentioned, unemployment is kind of a huge issue for me.
My whole life i've heard "Why don't you just get off your ass"
And still, i think that this homeopathic stuff is NONSENSE.
@ Genewitch- I would deal with my "critics" in the following manner: I would explain how a task which might be easy for them is a b#tch for me,*how* my condition interferes with skills involved in every-day living, interpersonal communication, et al. I would provide concrete examples of *how* difficult something was for me( e.g. studying for a difficult college exam/ writing a paper). Make it palpable, make it *real*. Some people will be understanding; you don't need the others' unsympathetic criticism or influence, doesn't sound very fair or kind to me. (BTW one of my main areas of study was cognitive psych) Best of luck to you!
Argentum nitricum? Silver nitrate?!?!??!??
Denice,
The problem with that is that even if it works in an individual case, it puts a lot of extra work on someone who is already having problems. For example, explaining to a judgmental person "how [one's] condition interferes with interpersonal communication" would be nontrivial. It's not something that Genewitch can do once and be done with; even if the people understand, accept, and remember what they've been told, they're not likely to pass the explanation on. (A diagnosis may be interesting gossip, the fine points maybe less so.)
Hyperion
Hyperion = pharma shill
Do you have any evidence, that by starting children on psychotropic medication that you can blunt them from being substance abusers. Not innuendo, not inference, no meta-analysis, no industry funded study, but actual scientific evidence like a controlled trial that shows a significant difference and follows children until their young adulthood.
Hmm. Let me think about this. Tell millions of kids they are broken and that a medication is required for their brokeness. A substance abuse to prophylactically treat a substance abuse. Makes total financial and pharmaceutical sense to me.
Didn't help this one.
http://www.msnbc.msn.com/id/42710178/ns/health-addictions
âI see the most tragic cases,â Miotto said. âFor example, there was a woman I saw who had been in medical school. She started misusing Adderall, and then she started needing more and more. Then she started doctor-shopping to get more medication.â
Eventually the woman became dependent on the drugs and flunked out of med school.
Do you have any evidence, that by starting children on psychotropic medication that you can blunt them from being substance abusers.
For those who are actually interested in the answer, as opposed to setting themselves up to deny any study which does not verify their a priori hypothesis because of "flaws", start with these.
http://www.ncbi.nlm.nih.gov/pubmed/17349106
http://www.ncbi.nlm.nih.gov/pubmed/12509561
http://www.ncbi.nlm.nih.gov/pubmed/16262593
and, you know, read them. track back through the referenced works. and come to your own conclusion, based on a synthesis of the literature, whether or not pharmacotherapy for ADHD with stimulant-class drugs leads to an enhanced liability for later substance abuse.
The issue of mis-use of therapeutic medications because of a perceived need to stay awake / focused to study is another one altogether. Particularly when they are intentionally faking symptoms to get the drugs....as is the point of that article on msnbc that you cite, augustine.
@ augustine: Here's a first for you. You provided a good citation about the dangers of using an adult ADD diagnosis for prescriptions for stimulant drugs. In clinical practice, we describe such patients as exhibiting drug-seeking behaviors. The survey describes instances where patients use the ADD diagnosis to convince their physician to write prescriptions.
As I stated in a prior post, parents of teenagers rush to the school district to get their children diagnosed with ADD or a Learning Disabled label...not for medication, but to get the kids "extra time" to complete college entrance exams...giving the kid the edge to score higher on the exams.
People who buy pain meds on the "street" and are addicted to Oxycontin, present major problems when they are hospitalized following surgery. It is difficult to titrate their pain medication...they need high doses for pain relief, while monitoring and slowly weaning them away from these powerful painkillers.
The converse of over-reliance on pain medicine is the stoic patient who "doesn't believe in pain medicine, beyond an occasional tylenol"; They are at extreme risk for decubiti, pneumonia and blood clots due to their refusal to ambulate and their beliefs about prescribed pain medication.
A major problem with studying whether stimulant medication for ADHD is a gateway to illegal drugs is that ADHD is a major risk factor for drug abuse anyway -- that is to say, how do you know whether they are doing drugs because they were used to Ritalin, or because they have ADHD (which is why they were prescribed Ritalin)? I would expect both to occur.
My hunch is that if you split all ADHD suffers up into "untreated", "treated without medication," and "treated with medication", the first group will have the highest rate of drug abuse. Probably significantly so, because they will have the lowest rate of self-control among the three groups. (Yeah, some people in each group will have lousy self-control; for various reasons, not everybody will be helped by treatment, pharmaceutical or otherwise.) What would be more interesting would be to find out the difference between the latter two groups. Does one group have a lower rate of substance abuse later in life, and if so, which one? (I'm assuming both groups get some kind of non-drug therapy, which I personally believe to be vital to a good prognosis with ADHD.)
Pharma monkey,
"Dr. Barkley is research professor of psychiatry at SUNY Upstate Medical University in Syracuse, and clinical professor of psychiatry at the Medical University of South Carolina in Charleston. He is a consultant to Eli Lilly and Shire; and is on the speakerâs bureaus of Eli Lilly, Janssen-Ortho, and Shire."
"In 2008, Congressional investigators charged that Dr. Biederman may have misreported to his institution income from drug companies between 2000 and 2007. This was reported by Gardiner Harris of the New York Times in an article titled 'Researchers Fail to Reveal Full Drug Pay'.[4]"
teh, teh, teh. You didn't answer the question. Even with your biased studies designed to create doubt. Remember tobacco science?
Show me a controlled trial without influence from the pharmaceutical corporations that demonstrate a significant difference in decreased substance abuse as a result of starting psychotropic medications.
Your not a skeptic monkey. You're a drug monkey.
You know, this Greasemonkey killfile add-on is working a treat.
NoNads,
It doesn't appear to be working for you.
As Calli Arcale mentioned in her post above there are other non-medical treatments that should be tried such as behavior modificaton/modeling with achievable goals. Parent involvement and training and interaction with teachers and psychologists at the child's school are essential components of the plan. Often, children with stereotypical ADD are able to handle the structure of a classroom without drugs; 50 % of children diagnosed with ADD do seem to respond completely... and are "decertified" (ADD diagnosis) by the education system, eventually.
It is a learning experience for the parents and the classroom teacher...every child who has that diagnosis is different with different strengths, different deficits and their ability to focus on tasks. They all respond to reinforcement of "good" behaviors with praise and small bribes (you get 10 minutes free time after you complete a task).
Augie, stop the nasty name-calling.
Here's a pretty good review of the literature published in Pediatrics:
http://pediatrics.aappublications.org/content/111/1/179.long
"Conclusion.Our results suggest that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders."
Poking around PubMed, there were a number of studies that similarly echo these findings. It makes a certain amount of sense, if a patient has a neurodevelopmental disorder that places them at a higher risk of developing a substance abuse disorder, then treating the neurodevelopmental disorder might prevent the issues that lead to substance abuse.
@ #66 lil,
The problem, of course, is that by your own math, 50% of them do not outgrow the diagnosis (and that matches the estimates in the literature). For those who don't outgrow the diagnosis, real life jobs do not provide IEPs and positive reinforcement.
Even for those who do outgrow the diagnosis, there's still valuable lessons and skills that they miss out on if not treated properly during that time. And outgrowing the diagnosis is not necessarily the result of the school system, it's a neurodevelopmental disorder, which literally means that as the child develops, symptoms will change, such as the noted lessening of hyperactive symptoms as patients age, even in those who don't outgrow the diagnosis.
While the long-term data from the MTA study is still inconclusive, the shorter-term data from that study indicated that medication alone was far more effective than Cognitive-Behavioral Therapy alone. My understanding is that there were not even significant differences between the medication-only and medication+therapy groups, although I think I remember reading that the medication+therapy group did show improvements on issues not directly related to the core symptoms, like family issues.
I'm a bit skeptical about the idea that parents are "rushing" to get their kids diagnosed solely for tests. I've not seen any data to indicate that diagnosis and treatment rates are significantly higher than the estimated prevalence rate, and I suspect that there are still a decent number of kids with the disorder who are not diagnosed.
As I said, given the estimated prevalence rate of 5% and the known adverse outcomes from lack of treatment, testing every kid when they enter 1st grade might not be a bad policy.
(and of course, when I say "medication" I mean the real, FDA-approved meds like methylphenidate (Ritalin) or amphetamine or atomoxetine, not this homeopathic crap)
@ hyperion: It seems we are in agreement. Many of these young children do appear to "outgrow" their early ADD diagnosis. I am in agreement that any delay in early childhood should be diagnosed and treated so that the child can fully benefit in the school setting.
What I said about the parents rushing to get their teens diagnosed with ADD or LD is anecdotal but true. I have friends who sit on the committees at district headquarters where they have seen this (unsuccesful) maneuver to get the edge on timed college entrance exams.
Homeopathic "medicines" do not work for these children just like homeopathic "medicines" do not work to control or cure any disorder or disease.
Re: oligotherapeutic.
"29 WTF is 'oligotherrapeutic'?
Posted by: Tsu Dho Nimh | May 20, 2011 3:32 PM"
"30 'Oligotherapeutic' = 'will only be therapeutic in a few cases.'
Posted by: Vicki | May 20, 2011 3:35 PM
"31 Oligotherapeutic" = homeopathic mineral water.
Posted by: sophia8 | May 20, 2011 4:13 PM"
In other words...
Fuck all use to just about anybody!
The product is one in a long line from Ionx LLC, which operates a number of worthless Hoeopathic brands sold under various names. I became aware of them when I ordered a product from their animal line - Vetionx - It was after I reelized I had been the victim of fraud that I began to research Ionx, HelloLife, MicroNutra, Techmedica - all the same outfit. They have been the subject of numerous FDA rulings and a variety of lawsuits, yet continue to operate.